Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Monday, April 04, 2011
    Life In Guatemala

    I walked in the back door of my house at 1:30 this morning, having left ten days previously. The Friday night of week before last I caught a shuttle to LAX, destination Guatemala City. I last went on this sort of trip four years previously and it had taken a little time for me to nerve myself to do it again.

    Our destination was a town in Guatemala called San Cristobal. I don't know exactly where it is, as I never saw a map. All I can tell you is that it is not the Mixco suburb of Guatemala City; it is about four and a half hours away from the airport by bus. San Cristobal is home to an actual hospital, built in a fit of generosity by the United States government in 1962 back when they were making the world safe for democracy. Sadly, most of it has stood empty as the local government has neither the money nor locally educated providers to staff it.

    I loved the building as soon as we walked in; I am old enough to remember the classic 1950's sort of hospital with green walls, linoleum floors and tile, and engraved plastic placards mounted over the door to tell you where you were. (e.g., "Emergencias.") This building was exactly like that. Hello, Dr. Ben Casey!

    The organization I worked with, HELPS International, emphasizes surgery on these trips. The surgeons (Plastics, ENT, OB/GYN, General) do much more good than we primary care MD's or GP's can do. If you are looking for a cause to support, I can highly recommend them. Despite the relative luxury of having an actual hospital to operate in, this was our toughest year yet - as I was told by several old hands who have been on many more trips than I have. Allow me to demonstrate.

    • A serious water shortage to the point that we were not allowed to flush the toilets or bathe. We were driven to use the bottled water (intended for drinking) to sterilize instruments in the autoclave before the water truck finally showed up.

    • Random power outages.

    • The hospital was host to a local Peds ward and emergency clinic. This meant that we were regularly woken by crying babies in the middle of the night. Let me tell you, those babies can raise the dead at that hour.

    • Our first night there we had a sobering experience: a hospital employee dropped dead of cardiac arrest. The locals threw him into an ambulance and rushed the poor guy into the ward in a wheelchair... I caught a glimpse as he was rushed past and instantly thought that he looked dead. The surgeons did CPR on him and got a pulse back, but he coded again in the ambulance and was DOA at the local "real" hospital. It turned out that he had a history of diabetes and had had a pacemaker placed three months before. In addition, he had been hospitalized the previous week for pulmonary edema.

    • A thyroidectomy patient who couldn't be extubated and needed MedEvac to Guatemala City.

    • This is a minor point, but our chef's skills were off. We were treated to undercooked bean soup, "vegetable lasagna" (veg cooked in tomato sauce without noodles. It would have been fine if they had explained that before we sat down to eat) and cold canned pea salad with mayo, cheese and chopped onion. I will pass over this chapter of the trip without comment.

    All that said, the camaraderie among the staff was outstanding; this is why people return year after year. I shared a dorm with five other women, mostly internists and one pediatrician. We chatted every night about spouses, medicine, the day's patients and everything else you could imagine. We got laughs out of the smallest of things. For instance, in most parts of Guatemala you can't drop used toilet paper into the toilet - the plumbing can't take it. You have to throw it into the trashcan. A couple days into our stay, one of my roommates glanced at the overflowing toilet bin and commented acidly, "I see maid service didn't come today." It sounds like a small thing, but we laughed like maniacs. We slept on cots I firmly believe were designed for Satan's Army - even our inflatable air mattresses didn't really help. After a full day of work they were comfortable to start with, but by the end of the night we were tossing and turning with every muscle in our torsos protesting.

    After the first rush of presurgical clearances was finished we clinicians were subject to, as one of my roommates termed it, "the bullshit parade." Duele todos in corpo soon became the last phrase any of us wanted to hear. Not to mention dolor in cabeza or back or foot pain. Our pediatrician announced one day at lunch, "I saw this lovely baby today, she was really kind of fat. Her mother told me she wasn't eating and hadn't eaten for a month. I'm looking at this Buddha baby and just said to the mother, "I don't believe you." (Not eating is apparently a favorite complaint among Guatemalan mothers.)

    I came up with a haiku one day, in a haze of clinic induced fatigue: Feet hurt all the time/Headache, neck ache and back ache/Gastritis, she says

    Next installment later... I have to get some sleep.

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    We chatted every night about spouses, medicine, the day's patients and everything else you could imagine. We got laughs out of the smallest of things. For instance, in most parts of Guatemala you can't drop used toilet paper into the toilet - the plumbing can't take it.

    I first learned about this practice during my earliest years at 10th Street Elem. We had parent volunteers who were from Guatemala, and I often found the trash in the staff restrooms overflowing with used toilet paper.

    Not so bad these days, but at the beginning--WOAH. Quite the mess and stench.

    By Blogger maryclev, at April 5, 2011 at 6:55 PM  

    Great post. Can't wait to hear more!

    By Blogger anna, at April 7, 2011 at 10:40 AM  

    I can't imagine not throwing dirty TP in the toilet. This whole post reminds me of the pre-employment drug test I took last week...it had pretty much all that except the dead guy and the cold garbanzo salad. :\ That being said, good on you!

    PS I have never, EVER slept on an air mattress that didn't deflate. Usually around 4 am, your butt is touching the floor. Is it just me or is there a weight limit or something I don't know about??

    By Blogger Pisser, at June 20, 2011 at 3:16 PM  

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